Operation Versus Watchful Waiting In Asymptomatic Or Minimally Symptomatic Inguinal Hernias:A Meta-analysis Of The Results

Objective:To compare and analyze the outcomes of surgical repair and watchful waiting in asymptomatic or minimally symptomatic inguinal hernias.Methods: The databases PubMed,Web of Science,EMBase and Springer were used to search for randomized controlled trials and comparative trials published to July 2017 which about surgical repair and watchful waiting in asymptomatic or minimally symptomatic inguinal hernias.The studies listed at the end of these articles as reference were also searched.Two authors independently screened literatures,evaluated the quality of each study and extracted relevant data,including pain,Physical Component Score(PCS),complications,mortality,and postoperative recurrence.Rev Man5.2 software was used to perform meta-analysis.The heterogeneity and influence on the overall difference for each group or sub group were tested,and fixed effect model or random effects model would be determined according to the results of heterogeneity.Publication bias was assessed with funnel plots,fail-safe number(Nfs)test and Egger's linear regression model.Results: A total of 2,817 patients enrolled into 7 randomized controlled trials and 1 retrospective clinical comparative study were included in this Meta-analysis.Less pain was observed in Operation group(P=0.04),and the Odds ratio(OR)was 0.57(95% confidence interval was 0.34,0.98).There were no significant differences in Physical Component Score(PCS)and mortality between WW group and Operation group.In addition,there were no difference in surgical complications and postoperative hernia recurrence between WW group and Operation group who accepted hernia repairs.But many patients will develop significant hernia-related symptoms and crossover to surgery over time in WW group.Conclusions: Patients have relative less pain in operation group compared with WW group,for the asymptomatic or minimally symptomatic inguinal hernias,WW is safe and feasible,but this strategy would merely delay rather than avoid surgical repair of hernias over time.